Smoking May Interfere With RA Treatment

People with early rheumatoid arthritis (RA) who smoke are less likely to respond to treatment with two of the most commonly used medications -- an older disease modifying antirheumatic drug called methotrexate and biologic drugs known as TNF blockers, according to a new study in January’s Arthritis & Rheumatism.

RA is an autoimmune disease that occurs when the body’s immune system misfires against its own joints and tissues, resulting in inflammation, swelling, pain, and ultimately the loss of mobility. Treating RA early with disease-modifying antirheumatic medications is considered the best way to stop this progressive disease in its tracks.

Previous research has shown that smoking can raise the risk for developing RA, says Theodore Fields, MD, clinical director of the Early Arthritis Initiative at Hospital for Special Surgery in New York City. “If you are at risk for RA, such as having RA in your family, don’t smoke because it does seem to be associated with onset and some data also suggest that it worsens RA that is already there.”

“This new study suggests that if you are a smoker, you are less likely to respond well to the most commonly used drugs. So the message is, if you are at risk of RA, don't smoke -- and if you already have RA, stop smoking,” he says. “We can’t say that stopping short-term will make you respond better, but the data is suggestive. The fact that people who were still smoking did worse suggests that it’s a good idea to stop.”

This new information may help people with RA quit smoking, he says. “Smoking is bad for your lungs and for your heart, but you are less likely to respond to RA treatment, and that may be one more stimuli for a patient to stop.”